Hypopharyngeal carcinoma (staging)

Hypopharyngeal carcinoma staging refers to TNM staging of carcinomas originating in the hypopharynx. This system most commonly applies to squamous cell carcinomas but can also apply to rarer epithelial malignancies in the region. The following article reflects the 8^th edition published by the American Joint Committee on Cancer, which is used for staging starting January 1, 2018 ^1,2.

Primary tumor (T)

• TX: primary tumor cannot be assessed

• Tis: carcinoma in situ

• T1:

  • tumor limited to one subsite of hypopharynx (left or right pyriform sinuses, posterior hypopharyngeal wall, or postcricoid region), and/or

  • tumor ≤2 cm in greatest dimension

• T2:

  • tumor extends into adjacent subsite of hypopharynx or adjacent site (larynx, oropharynx), and/or

  • tumor >2 cm and ≤4 cm without fixation of hemilarynx

• T3:

  • tumor >4 cm, or

  • clinical fixation of hemilarynx, or

  • extension to esophageal mucosa

• T4: moderately advanced and very advanced local disease

  • T4a: moderately advanced local disease in which tumor invades one or more of the following: 

    • thyroid cartilage

    • cricoid cartilage

    • hyoid bone

    • thyroid gland

    • esophageal muscle

    • central compartment soft tissue (prelaryngeal strap muscles and subcutaneous fat)

  • T4b: very advanced local disease in which tumor encases carotid artery or invades one or more of the following:

    • mediastinal structures

    • prevertebral fascia

Regional lymph node (N)

Regional nodal status is defined the same as for most other cancers of the head and neck. See the main article, cervical lymph node (staging).

Distant metastasis (M)

The terms pM0 and MX are not valid TNM categories. The following categories may be used:

• cM0: no evidence of metastases

• cM1: distant metastasis

• pM1: distant metastasis, microscopically confirmed

Stage groups

The prognostic stage groups are defined the same as for most other cancers of the head and neck:

• Stage 0

  • Tis, N0, M0

• Stage I

  • T1, N0, M0

• Stage II

  • T2, N0, M0

• Stage III

  • T3, N0, M0

  • [T1, T2, T3], N1, M0

• Stage IVA

  • T4a, [N0, N1], M0

  • [T1, T2, T3, T4a], N2, M0

• Stage IVB

  • [Any T], N3, M0

  • T4b, [Any N], M0

• Stage IVC

  • [Any T], [Any N], M1

Changes since prior versions

Since the 7th edition, the T3 criterion of esophageal invasion has been split into esophageal mucosa involvement (T3) and esophageal muscle (T4). Nodal staging has changed, as with other head and neck sites, to emphasize extranodal extension.

See also

• squamous cell carcinoma of the aerodigestive tract of the head and neck

• squamous cell carcinoma of the hypopharynx